1 / 24

Playing by the Rules : Integrated Care's Impact on Quality of ADHD Management

Session F1b October 17 th , 2014. Playing by the Rules : Integrated Care's Impact on Quality of ADHD Management. Tawnya Meadows, Ph.D., BCBA-D Shelley J. Hosterman , Ph.D. Collaborative Family Healthcare Association 16 th Annual Conference

Download Presentation

Playing by the Rules : Integrated Care's Impact on Quality of ADHD Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Session F1b October 17th, 2014 Playing by the Rules: Integrated Care'sImpact on Quality of ADHD Management Tawnya Meadows, Ph.D., BCBA-D Shelley J. Hosterman, Ph.D Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

  2. Faculty Disclosure • We have not had any relevant financial relationships during the past 12 months.

  3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Identify simple data collection procedures to measure outcomes on standards of care outcomes. • Compare ADHD outcomes in three domains between Integrated versus comparison sites. • Identify procedures implemented to impact standards of care adherence. • Discuss other pediatric standards of care in which behavioral health care can impact patient experience and outcomes.

  4. Bibliography / Reference • American Academy of Pediatrics [AAP], 2000, 2001, 2011 • Epstein, J. N., Langberg, J. M., Lichtenstein, P., Kolb, R., & Stark, L. (2010). Sustained Improvement in Pediatricians' ADHD Practice Behaviors in the Context of a Community-Based Quality Improvement Initiative. Children’s Health Care. Association for the Care of Children's Health, 39: 296-311. • Sheldrick, R. C., Leslie, L. K., Rodday, A. M., Parsons, S. K., Saunders, T. S., & Wong, J. B. (2012). Variations in Physician Attitudes Regarding ADHD and Their Association With Prescribing Practices. Journal of Attention Disorder. DOI: 10.1177/1087054712461689. • Wolraich, M. L. (2012). The new attention deficit hyperactivity disorder clinical practice guidelines published by the American Academy of Pediatrics. Journal of developmental and behavioral pediatrics, 33(1):76-7. • Fothergill, K.E., Gadomski, A., Solomon, B.S., Olson, A.L., Gaffney, C.A., dosReis, S., & Wissow, L.S. (2013). Assessing the Impact of a Web-Based Comprehensive Somatic and Mental Health Screening Tool in Pediatric Primary Care. Academic Pediatrics, 13 (4), 340–347.

  5. Learning Assessment • A learning assessment is required for CE credit. • A question and answer period will be conducted at the end of this presentation.

  6. Introduction

  7. Assessment and treatment of ADHD • Greatly consumes PCP’s clinical attention and resources • 15% of pediatric PC practice consists of BX disorders (ADHD most frequent). • 75% of ADHD patients are seen in PC, but only 2% see BH specialists • One-third to half of pediatric BH referrals are for ADHD • At 3-10% of school-aged children, ADHD is the most common childhood BH diagnosis • PCPs complete 1-2 new ADHD evaluations/month & most spend 15-45 minutes at at least 2 visits to reach diagnosis5

  8. AAP Guidelines • Initiate evaluation when a child presents with ADHD-like symptoms • Document that child meets DSM-IV criteria • Obtain evidence from parents regarding core symptoms across settings, age of onset, duration of symptoms, and degree of impairment • Retrieve information from teachers or school personnel • Assess for coexisting conditions |

  9. Multiple Barriers • Less than 25% of physicians are familiar with & implement AAP guidelines in their practice • Lack of training • Limited time • Difficult to coordinate information with school/teachers |

  10. Possible Solution: PCBH • Behavioral health specialists located within a pediatrician’s office can assist with meeting practice guidelines. • High customer satisfaction • Low dropout rates • Increased cost effectiveness • Support adherence to standards of care • Assist in monitoring of treatment & providing behavioral support |

  11. Methods

  12. Methods: • Physician surveys: • 6-17 IPC & 24-54 control PCPs • Reported on use of screening tools & comfort in diagnosing ADHD • Chart Review: • Key variables in PCP & IPC BH provider documentation within EHR • Onset, diagnosis, medication, use of rating scales, family hx, comprehensive physical & neurological exam, use of BH services |

  13. Intervention • REACH training • Psychologists on site • Increased availability of rating forms • Change of ADHD template |

  14. Results

  15. Survey Results: Screening Instrument Use • PCPs in IPC clinics report significantly higher use of BH screening instruments compared to PCPs in control clinics (p< .01)

  16. Survey Results: PCP Comfort Diagnosing • IPC PCPs report increased comfort in dx (*p< .01) |

  17. Survey Results: Comfort in Managing • IPC PCPs reported increased comfort in managing ADHD at year one (p< .01) |

  18. Survey Results: PCP Knowledge • IPC PCPs reported increased knowledge of common psychotropic medications and treatment post integration(p< .01) |

  19. Chart Review: Demographics |

  20. Chart Review: Assessment Adherence |

  21. Chart Review: PCP Treatment Adherence |

  22. | • Conclusions/Implications

  23. Implications • All providers were not equal in documentation of standards of care.

  24. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!

More Related